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1
LOVE BUSTERS QUESTIONNAIRE
All couples that are using this questionnaire must buy the book, Fall in Love Stay in Love by Willard F. Harley, Jr.1. Angry Outbursts. Deliberate attempts by your spouse to hurt you because of anger toward you. They are usually in the form of verbal or physical attacks.
A. Angry Outbursts as a Cause of Unhappiness: Indicate how much unhappiness you tend to experience when your spouse attacks you with an angry outburst.0 1 2 3 4 5 6
I experience I experience I experience no unhappiness moderate unhappiness extreme unhappiness
B. Frequency of Spouse's Angry Outbursts: Indicate how often your spouse tends to engage in angry outbursts toward you. _____ (write number) angry outbursts each day / week / month / year (circle one) C. Form(s) Angry Outbursts Take: When your spouse engages in angry outbursts toward you, what does he or she typically do?___________________________ _______________________________________________________ _______________________________________________________ D. Form of Angry Outbursts That Causes the Greatest Unhappiness:Which of the above forms of angry outbursts causes you the greatest unhappiness?
________________________________________________________________ _______________________________________________________ _____________________________________________________________E. Onset of Angry Outbursts:
When did your spouse first engage in angry
outbursts toward you?______________________________________________ _______________________________________________________
_____________________________________________________________F. Development of Angry Outbursts:
Have your spouse's angry outbursts increased
or decreased in intensity and/or frequency since they first began? How do recent angry outbursts compare to thoseof the past? ___________________________ _______________________________________________________
_______________________________________________________ 22. Disrespectful judgments. Attempts by your spouse to change your attitudes, beliefs,
and behavior by trying to force you into his way of thinking. If (1) your spouse lectures you instead of respectfully discussing issues, (2) feels that his or her opinion is superior to yours, (3) talks over you or prevents you from having a chance to explain your position, or (4) ridicules your point of view, your spouse is engaging in disrespectful judgments. A. Disrespectful Judgments as a Cause of Unhappiness: Indicate how much unhappiness you tend to experience when your spouse engages in disrespectful judgments.0 1 2 3 4 5 6
I experience I experience I experience
no unhappiness moderate unhappiness extreme unhappiness
B. Frequency of Spouse's Disrespectful Judgments: Indicate how often your spouse tends to engage in disrespectful judgments toward you. _____ (write number) disrespectful judgments each day / week / month / year (circle one) C. Form(s) Disrespectful Judgments Take: When your spouse engages in disrespectful judgments toward you, what does he or she typically do? ____________________________________________________ ____________________________________________________ ____________________________________________________ D. Form of Disrespectful Judgments That Causes the Greatest Unhappiness: Which of the above forms of disrespectful judgments causes you the greatest unhappiness? ________________________________________________ ____________________________________________________ ____________________________________________________ __________________________________________________________ E. Onset of Disrespectful Judgments: When did your spouse first engage in disrespectful judgments toward you?_______________________________ ____________________________________________________ ____________________________________________________ F. Development of Disrespectful Judgments: Have your spouse's disrespectful judgments increased or decreased in intensity and/or frequency since they first began? How do recent disrespectful judgments compare to those of the past? _____________________________________________________ _____________________________________________________ _____________________________________________________ 33. Annoying Behavior. The two basic types of annoying behavior are habits and
activities. Habits are repeated without much thought, such as the way your spouse eats or sits in a chair. Activities are usually scheduled and require thought to complete, such as attending sporting events or engaging in a personal exercise program. Habits and activities are "annoying behavior" if they cause you to feel unhappy. They can be as innocent as snoring or as destructive as infidelity or alcohol addiction. A. Annoying Behavior as a Cause of Unhappiness: Indicate how often your spouse tends to engage in annoying behavior.0 1 2 3 4 5 6
I experience I experience I experience
no unhappiness moderate unhappiness extreme unhappiness
B. Frequency of Spouse's Annoying Behavior: Indicate how often your spouse tends to engage in annoying behavior. _____ (write number) occurrences of annoying behavior each day / week / month year (circle one) C. Form(s) Annoying Behavior Takes: When your spouse engages in annoying behavior toward you, what does he or she typically do?___________________ ______________________________________________________ ______________________________________________________ D. Form of Annoying Behavior That Causes the Greatest Unhappiness: Which of the above forms of annoying behavior causes you the greatest unhappiness? ___________________________________________________ ______________________________________________________ ______________________________________________________E. Onset
of Annoying Behavior:When did your spouse first engage in
annoying behavior?_ ______________________________________________ ______________________________________________________ ______________________________________________________ F. Development of Annoying Behavior: Has your spouse's annoying behavior increased or decreased in intensity and/or frequency since it first began? How do recent annoying behavior compare to that of the past? ______________________________________________________ ______________________________________________________ ______________________________________________________ 44. Selfish Demands. Attempts by your spouse to force you to do something for him or
her, usually with implied threat of punishment if you refuse. A. Selfish Demands as a Cause of Unhappiness: Indicate how much unhappiness you tend to experience when your spouse engages in disrespectful judgments.0 1 2 3 4 5 6
I experience I experience I experience
no unhappiness moderate unhappiness extreme unhappiness
B. Frequency of Spouse's Selfish Demands: Indicate how often your spouse makes selfish demands of you. _____ (write number) disrespectful judgments each day / week / month / year (circle one) C. Form(s) Selfish Demands Take: When your spouse makes selfish demands of you, what does he or she typically do? ____________________________________________________ ____________________________________________________ ____________________________________________________ D. Form of Selfish Demands That Causes the Greatest Unhappiness: Which of the above forms of selfish demands causes you the greatest unhappiness? ________________________________________________ ____________________________________________________ ____________________________________________________ E. Onset of Selfish Demands: When did your spouse first make selfish demands of you? ______________________________________________________ ____________________________________________________ ____________________________________________________ F. Development of Selfish Demands: Have your spouse's selfish demands increased or decreased in intensity and/or frequency since they first began?How do recent selfish demand
s compare to those of the past? _____________________________________________________ _____________________________________________________ _____________________________________________________ 55. Dishonesty. Failure of your spouse to reveal his or her thoughts, feelings, habits,
likes, dislikes, personal history, daily activities, and plans for the future. Dishonesty is not only providing false information about any of the above topics, but it is also leaving you with what your spouse knows is a false impression. A. Dishonesty as a Cause of Unhappiness: Indicate how much unhappiness you tend to experience when your spouse is dishonest with you.0 1 2 3 4 5 6
I experience I experience I experience
no unhappiness moderate unhappiness extreme unhappiness